The North Carolina State Health Plan for Teachers and State Employees’ blanket exclusion on paying for gender-confirming care unlawfully discriminates against transgender employees and their dependents on the basis of sex, a federal court said.
This is one of several cases throughout the country disputing government health plans’ limitations on paying for medically necessary transition-related care, including surgeries such as hysterectomies and vaginoplasties.
Section 1557 of the Affordable Care Act prohibits discrimination in “any health care program or activity” that receives federal money. It expressly incorporates Title VI, which prohibits discrimination based on race, color, and national origin, and Title IX, which prohibits discrimination in educational programs. Courts evaluating this provision also look to cases interpreting Title VII, which prohibits employment discrimination, to determine if a policy violates the ACA, the US District Court for the Middle District of North Carolina said.
The NCSHP’s exclusion “necessarily rests on a sex classification” because it would be impossible to determine if a particular treatment is connected to gender-confirming care without considering a person’s biological sex, the court said. The court relied on the US Supreme Court’s reasoning in Bostock v. Clayton County, where it held that an employer can’t...
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